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Atlas of Craniopharyngioma: Pathology, Classification and Surgery PDF

166 Pages·2020·33.942 MB·English
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Songtao Qi Editor Atlas of Craniopharyngioma Pathology, Classification and Surgery 123 Atlas of Craniopharyngioma Songtao Qi Editor Atlas of Craniopharyngioma Pathology, Classification and Surgery Editor Songtao Qi Neurosurgery Department of Nanfang Hospital Southern Medical University Guangzhou Guangdong China ISBN 978-981-13-7321-3 ISBN 978-981-13-7322-0 (eBook) https://doi.org/10.1007/978-981-13-7322-0 © Springer Nature Singapore Pte Ltd. 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Foreword This is a timely book. The application of endoscopy, new advanced media in imaging, surgical preparation, intraoperative navigation, and imaging have quite literally opened up the surgical view of deep-seated lesions in critical locations. Craniopharyngiomas are the quintessential deep-seated, midline lesion surrounded by critical structures; this surgical atlas provides the necessary surgical roadmap to guide these surgical journeys. The author group, Prof Qi and his team at Nanfang Hospital, have accumulated a unique experience with a wide range of surgical material and their insights and pearls are of immense value to those who do not have the advantage of their catchment. It will become a valuable addition in the operative arsenal of the neurosurgeon. Nelson M. Oyesiku Neurosurgery and Medicine (Endocrinology) Emory University School of Medicine Atlanta, GA, USA Emory Pituitary Center Emory University School of Medicine Atlanta, GA, USA Department of Neurosurgery Emory University School of Medicine Atlanta, GA, USA v Preface Craniopharyngioma is defined by the WHO as an intracranial benign tumor that cannot be cured due to anatomical factors. Surgery, radiotherapy, cystic aspiration, and internal irradia- tion or intracapsular chemotherapy are considered as “proper” treatment options for cranio- pharyngioma. Partial surgical resection combined with stereotactic radiotherapy is applied in many medical centers, which results in craniopharyngioma being basically incurable, and even if the patient has long-term survival, health is impaired and quality of life is low. Since 1998, our team has treated approximately 1000 cases of primary and recurrent cranio- pharyngioma for curative purposes. Approximately 800 cases were admitted in our centers and received systematic clinical therapy. The total resection rate of primary craniopharyngioma from 1998 to 2003 was approximately 85%, which has reached the level reported in the Yasargil period, and the total tumor resection rate from 2004 to 2008 was nearly 90%. From 2009 to the present (2018, May), the total resection rate is higher than 95% and there were no perioperative deaths in the past three years. We have progressed greatly in craniopharyngioma treatment in the past 20 years because we have been focusing on the effects of tumor origin and membranous structures on the tumor growth pattern through clinical, embryonic, and histological studies. The QST classification of craniopharyngioma based on tumor origin and surrounding membranous structures was estab- lished. This classification has the following advantages compared with the previous important classification. First, this classification is in line with the embryonic origin theory and is not concerned with the notion of “intra-third ventricle craniopharyngioma,” which leads to the misconception that tumors can originate in the third ventricle. Second, some large and com- plex craniopharyngiomas can be well classified by the QST system, and this system can more accurately reflect the relationship between the tumor and important structures such as the hypothalamus, so as to facilitate the correct surgical approach. Third, the QST system is not only related to the symptoms, endocrine status, and pathological types of patients, but also reflects the difficulty of surgery in different cases and accurately determines the prognosis. The previous classifications may have not paid sufficient attention to the origin of the tumor. Some classifications were only based on clinical observation and the experience of the surgeon that did not emphasize the embryonic origin of craniopharyngioma. Some other classifications are only based on the relative relationship between important structures and the tumor. Some are even based on the relative position of the third ventricle, which also does not emphasize the pathological relationship between the tumor and the hypothalamic tissue. These resulted in the need for a long learning curve for doctors or lead to failure in successfully treating a cranio- pharyngioma, and also lead to the view that craniopharyngiomas involving the third ventricle floor are not suitable for surgical resection. This is also the root cause why conservative treat- ments for craniopharyngioma are still advocated and the belief that this benign tumor cannot be cured. In the past 20 years, our team carried out systematic and comprehensive research on cranio- pharyngioma. The chief editor of this atlas, Professor Qi Songtao, achieved a total resection rate of 97% in approximately 600 craniopharyngioma cases. Some patients can maintain func- tional hypothalamic-pituitary secretion and some patients even had restored fertility. The main content of this atlas includes the development of craniopharyngioma from the embryonic vii viii Preface perspective, the microanatomy of surrounding membranous structures, the histopathological relationship between the tumor and the adjacent structures, and the QST classification and its application in transcranial and transsphenoidal approaches. Although craniopharyngioma has become a curable intracranial tumor in the author’s cen- ter, it is undeniable that it is a task for neurosurgeons to deal with this benign tumor due to its strategic location and malignant biological behavior. This is also the purpose of our atlas. We will feel gratified if more patients can safely undergo total resection, rather than partial resec- tion plus radiotherapy, chemotherapy, or immunotherapy. Craniopharyngioma is a long-term disease in the clinical process. We have numerous col- leagues in this field and cannot list them all in this book. However, their contribution will defi- nitely be remembered forever. Guangzhou, China Songtao Qi 2018-8-30 Contents Part I T he Basics of Craniopharyngioma 1 H istology and Embryology Related to Craniopharyngiomas . . . . . . . . . . . . . . . . . . 3 Shi-chao Zhang and Chao-hu Wang 2 Surgical Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Xi’an Zhang, Yun-tao Lu, and Songtao Qi 3 Q ST Classification for Craniopharyngioma and Histopathological Aspect . . . . . . 13 Yi Liu, Chao-hu Wang, and Songtao Qi 4 C omparison Between the QST Scheme and Other Schemes for Craniopharyngiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Yun Bao and Songtao Qi Part II S urgical Treatment of Craniopharyngioma 5 Endoscopic Transsphenoidal Surgery for Craniopharyngioma . . . . . . . . . . . . . . . . 37 Jun Fan, Yi Liu, and Songtao Qi 6 S urgical Treatment of Craniopharyngioma: Transcranial Approach . . . . . . . . . . . 61 Jun Pan, Jun-xiang Peng, and Song-tao Qi Part III Recurrent Craniopharyngioma 7 Treatment of Recurrent Craniopharyngioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105 Jing Nie Part IV O ther Aspects of Craniopharyngioma 8 Retreatment of Craniopharyngioma After External Radiotherapy and Intracapsular Radiochemotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .151 Jun-xiang Peng, Yun Bao, and Songtao Qi 9 B asic Research in Craniopharyngioma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159 Zhan-peng Feng, Yi Liu, Chao-hu Wang, and Songtao Qi ix About the Editor Chief editor: Songtao Qi Associate editors: Jun Pan, Yi Liu, Xi’an Zhang, and Jun Fan Editors: from left to right sitting in the first row: Jun Fan, Xi-an Zhang, Songtao Qi, Jun Pan, Yun-tao Lu, and Yi Liu; from left to right in the second row: Jing Nie, Jun-xiang Peng, Jin Shi, Chao-hu Wang, Zhan-peng Feng, Shi-chao Zhang, and Yun Bao xi Part I The Basics of Craniopharyngioma

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